Wilcoxon Test Research Articles

Modelling and assessment of glucose-lactate kinetics in youth withoverweight, obesityand metabolic dysfunction-associated steatotic liver disease: A pilot study.

In this study, we investigated glucose and lactate kinetics during a 75 g oral glucose tolerance test (OGTT) in 23 overweight and obese adolescents and assessed putative differences among participants with and without metabolic dysfunction-associated steatotic liver disease (MASLD). We enrolled 23 young people (six girls) with obesity [body mass index 33 (29-37)]. Glucose-lactate kinetics parameters (disposal glucose insulin sensitivity, SID; fraction of glucose converted into lactate, fr; fractional lactate clearance rate, kL) and lactate production rate (LPR) were estimated using the oral glucose-lactate minimal model. MASLD presence was assessed using the proton density fat fraction. We analysed glucose, lactate and LPR time to peak, peak values and area under the curve and evaluated differences using the Wilcoxon test. MASLD and no-MASLD participants were compared using the Mann-Whitney test. Correlations between parameters were assessed using the Spearman correlation coefficient (ρ). We also tested the performance of two (4 or 3 h OGTT) protocols in estimating oral glucose-lactate minimal model and LPR parameters. Glucose peaks 30 min earlier than lactate (p = .0019). This pattern was present in the no-MASLD group (p < .001). LPR peaks 30 min later in the MASLD group (p = .02). LPR and kL were higher in MASLD, suggesting higher glycolysis and lactate utilization. SID and fr correlate significantly (ρ = -0.55, p = .008). SID and fr were also correlated with the body mass index, (ρ = -0.45, p = .04; and ρ = 0.45; p = .03). The protocol duration did not influence the estimates of the parameters. Youth with MASLD showed a delayed glucose metabolism, possibly because of greater utilization of the underlying substrates. A 3-h OGTT may be used to assess lactate metabolism effectively.

Prevalence of Liver Steatosis in Tuberous Sclerosis Complex Patients: A Retrospective Cross-Sectional Study.

Introduction: Tuberous sclerosis complex (TSC) is a genetic disease caused by pathogenetic variants in either the TSC1 or TSC2 genes. Consequently, the mechanistic target of the rapamycin complex 1 (mTORC1) pathway, a regulator of cell growth, metabolism, and survival, becomes inappropriately activated, leading to the development of benign tumors in multiple organs. The role of mTORC1 in lipid metabolism and liver steatosis in TSC patients has not been well-studied, and clinical data on liver involvement in this population are scarce. Methods: We conducted a retrospective, cross-sectional study to compare liver steatosis in TSC patients with age-, sex-, BMI-, and diabetes status-matched controls. Participants with a definite diagnosis of TSC were recruited from the TSC clinic at UZ Brussel. Liver steatosis was quantified using the fat signal fraction from in-phase and out-of-phase MRI, with a threshold of ≥5% defining the presence of steatosis. We also evaluated the prevalence of liver angiomyolipomata in the TSC group and analyzed risk factors for both liver steatosis and angiomyolipomata. Results: The study included 59 TSC patients and 59 matched controls. The mean fat signal fraction was 4.0% in the TSC group and 3.9% in the controls, showing no significant difference (two-tailed Wilcoxon signed ranks test, p = 0.950). Liver steatosis was observed in 15.3% of TSC patients compared to 23.7% of the controls, which was not statistically significant (two-tailed McNemar test, p = 0.267). Liver angiomyolipomata were identified in 13.6% of the TSC cohort. Conclusions: Our study, describing in detail the liver phenotype of TSC patients, did not reveal a significant difference in the prevalence of MRI-assessed liver steatosis in a large cohort of TSC patients compared to a closely matched control group.

A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol

BackgroundHigh-energy re-feeding protocols are increasingly utilised for nutritional rehabilitation in adolescents with anorexia nervosa (AN), however, concern persists that adults with AN may be at greater risk of developing complications. In addition, research on psychological outcomes of eating disorder (ED) inpatient treatment programs, and outcomes of high-energy protocols in avoidant restrictive food intake disorder (ARFID) and bulimia nervosa (BN), is limited. This study of an ED inpatient program using a high-energy protocol, compared changes in weight and psychosocial outcomes between adolescents and adults, and identified medical risk factors associated with deviation from the protocol.MethodThis prospective observational study took place in a voluntary ED treatment program in a private hospital. Weight, height, and psychosocial questionnaires (ED Examination-Questionnaire, Depression Anxiety Stress Score, Clinical Impairment Assessment and AN/BN Stage of Change) were collected from consenting adolescents (16–20 years) and adults (> 20 years) on admission and discharge. Medical tolerance to the high-energy protocol was assessed daily. Independent samples t-tests and paired samples t-tests were applied to normally distributed data, and Mann–Whitney U tests and Wilcoxon signed-rank tests to skewed data. P-values < 0.05 were considered significant statistically.ResultsNinety-seven participants were recruited. The majority (n = 91, 94%) were female and most (n = 80, 83%) had AN. Forty-two (43%) were adolescents and 55 (57%) were adults. In participants with AN, weight change (Δ) was significant [median Δ 8.0 (interquartile range (IQR) 4.3) kg]. There was no difference in rate of weight change between adolescents and adults with AN [mean Δ 1.8 (standard deviation (SD) 0.5) kg/week vs. Δ 1.8 (SD 0.6) kg/week; p = 0.841, respectively]. One (1%) participant with AN did not tolerate the high-energy protocol due to oedema. Participants achieved positive change in psychosocial questionnaire scores (p < 0.001) after the the specialist ED program, with no difference between adolescents and adults (p > 0.05).ConclusionsThis voluntary ED treatment program using a high energy re-feeding protocol was effective in achieving positive weight and psychological change for adolescents and adults with minimal adverse events. This indicates that the specialist ED program has both nutritional and psychological benefits.

Characterization of the SPIRITAS: A Disposable Sampling Setup for Volatile Organic Compound Collection and Analysis

Analyzing exhaled breath for volatile organic compounds (VOCs) using thermal desorption–gas chromatography–mass spectrometry (TD-GC-MS) offers a non-invasive diagnostic approach for various diseases. Despite its promise, the method faces challenges like sampling heterogeneity and high costs. Following the European Respiratory Society’s advocacy for methodological standardization, we developed the SPIRITAS (Standardized Product for Inexpensive Respiratory InvesTigation: A breath Sampler), a low-cost, disposable breath sampler. This study evaluates the SPIRITAS’s effectiveness in detecting targeted VOCs. We tested the SPIRITAS using the Peppermint Experiment, a standardized protocol that allows for comparison between different breath sampling and analytical practices by assessing the ability to detect five peppermint-specific VOCs after ingestion of a 200-milligram peppermint oil capsule. We included ten subjects and performed six breath samples per participant, including a baseline measurement taken before ingestion. We used the Wilcoxon signed-rank test to evaluate whether baseline values were significantly lower than the peak values of the targeted VOCs. Additionally, we conducted an experiment utilizing humidified medical-grade air to identify any VOCs attributable to the SPIRITAS setup itself. Results showed successful detection of four out of five targeted “peppermint-associated” VOCs: alpha-pinene (p ≤ 0.01), beta-pinene (p ≤ 0.01), menthone (p = 0.01), and menthol (p = 0.02), indicating significant differences between the baseline and peak values in the volunteers’ breath. However, detection of eucalyptol was inconsistent. In addition, we identified 16 VOCs that were released by the SPIRITAS, one of which remains unidentified. Our findings underscore the SPIRITAS’s potential for clinical applications, paving the way for broader biomarker research. The combination of ease of use, low cost, reduced risk of contamination, and standardization makes SPIRITAS very suitable for large-scale international studies. Furthermore, we have demonstrated the SPIRITAS’s effectiveness in detecting specific VOCs and identified 16 compounds originating from the SPIRITAS, ensuring that these compounds would not be mis-qualified as potential biomarkers in future clinical studies.

Disaster Risk Management Model for Enhancing the Preparedness of Pregnant Women in Response to the Eruption of Mount Agung: A Quasi-Experimental Study

Background: Volcanic eruptions can harm pregnant women in the absence of disaster risk management. Health personnel have not adequately prepared pregnant women for disaster-prone eruptions. Objectives: This research aimed to evaluate the effectiveness of a disaster risk management model in enhancing the preparedness of pregnant women in anticipation of the eruption of Mount Agung. Methods: The research employed a quasi-experimental design, utilizing a pre-test-post-test control group method. Conducted in Bali, Indonesia, in 2022, the study involved a sample of 200 participants, divided equally into two groups of 100 each. Participants were selected using quota sampling. Preparedness questionnaires were administered before the educational intervention (pre-test) and again after two weeks of education (post-test). The data were analyzed using the Wilcoxon Signed Rank Test and the Mann-Whitney U test. Results: It was found that in the intervention group, the preparedness of most pregnant women was categorized as fair (55%) before the intervention and high (65%) after the intervention (p &lt; 0.001). In the control group, most pregnant women's preparedness remained in the fair category both before (66%) and after (65%) the intervention (P = 0.085). Additionally, there was a significant difference in the preparedness levels between the groups after the intervention (P = 0.015). Conclusions: Health workers can enhance the eruption emergency preparedness of pregnant women through educational classes specifically designed for them.

Magnesium citrate monotherapy improves RLS symptoms and multiple suggested immobilization test scores in an open-label pilot study.

An estimated 3% of the population suffers from clinically significant restless legs syndrome. Given the limited pharmacological options in the arsenal, there is a need for a therapeutic agent with a better side effect profile. Twelve treatment naïve adults (10 women and 2 men with a median age of 41.5 [32-48.5] years) with primary RLS were recruited in our open-label pilot study; magnesium citrate 200 mg was administered daily for eight weeks. Serum magnesium levels, IRLS, Kohnen QOL scale, and multiple suggested immobilization tests were performed before and after supplementation. Paired t-tests and Wilcoxon signed-rank tests were used for data analysis. Pearson and Spearman's analyses assessed the association between magnesium levels and RLS variables. Participants had a significant reduction in IRLS scores (- 6.67 [2.33-11] p=0.006) and improved Kohnen QOL scores (-8.5 [2.09-14], p=0.014) without notable differences in serum magnesium levels (p=0.3). Average PLMW across all SIT trials (30.40 [5.20, 122.40] to 8.63 [0.32, 17.47] p=0.043) and subjective measures on mSIT also demonstrated improvement. Serum magnesium levels negatively correlated with m-SIT self-reported scores and the PLMW indices. Despite the limitations of open-label design, our study's positive results indicate the need for a placebo-controlled trial with a larger sample size. clinicaltrials.gov (NCT04462796).

The Effective British Broadcasting Corporation’s (BBC) Optimal Pronunciation Vocational School's (OPVS) Podcast

The objective of this initiative is to improve pronunciation fluency in vocational schools by including a British accent. This study utilized the Wilcoxon signed-rank test as a component to collect both quantitative and qualitative data on product moment SPSS. The data was acquired by pronunciation evaluation test and analysis questions. The data employed in this study was gathered from a vocational school consisting of thirty students enrolled in a hospitality industry and cooking programme. The mean test score is 8.00, and the total amount of ranks is 120.00. According to the statistical test output provided, it is referred to as Asymp. The p-value (two-tailed) is 0.001. Based on the test statistics output above, it is known that Asymp. Sig. (2-tailed) has a value of 0.001, because the value of 0.001 is smaller than 0.05, it can be concluded there is a difference between learning outcomes using text transcripts and shadowing BBC Podcasts and those that do not use text transcripts and shadowing BBC Podcasts. The podcast produced by the BBC can enhance language acquisition by improving pronunciation skills, stimulating students' motivation to achieve English competence, and assisting listeners in developing a predominantly British accent

Frequency and phase correction of GABA-edited magnetic resonance spectroscopy using complex-valued convolutional neural networks

PurposeTo determine the significance of complex-valued inputs and complex-valued convolutions compared to real-valued inputs and real-valued convolutions in convolutional neural networks (CNNs) for frequency and phase correction (FPC) of GABA-edited magnetic resonance spectroscopy (MRS) data. MethodsAn ablation study using simulated data was performed to determine the most effective input (real or complex) and convolution type (real or complex) to predict frequency and phase shifts in GABA-edited MEGA-PRESS data using CNNs. The best CNN model was subsequently compared using both simulated and in vivo data to two recently proposed deep learning (DL) methods for FPC of GABA-edited MRS. All methods were trained using the same experimental setup and evaluated using the signal-to-noise ratio (SNR) and linewidth of the GABA peak, choline artifact, and by visually assessing the reconstructed final difference spectrum. Statistical significance was assessed using the Wilcoxon signed rank test. ResultsThe ablation study showed that using complex values for the input represented by real and imaginary channels in our model input tensor, with complex convolutions was most effective for FPC. Overall, in the comparative study using simulated data, our CC-CNN model (that received complex-valued inputs with complex convolutions) outperformed the other models as evaluated by the mean absolute error. ConclusionOur results indicate that the optimal CNN configuration for GABA-edited MRS FPC uses a complex-valued input and complex convolutions. Overall, this model outperformed existing DL models.

Effects of Online Cooperative Learning (OCL) Student Teams Achievement Division (STAD) Method to the Motivation, Self – efficacy, And Academic Achievement of Students in Science 10

This study explores the impact of Online Cooperative Learning (OCL) using the Student Teams Achievement Divisions (STAD) method on science 10 students’ self-efficacy, motivation, and academic achievement. Conducted at Ocampo National High School during the COVID-19 pandemic, the quasi-experimental design involved 90 tenth-grade students split into control and treated groups. Pre- and post-experiment assessments included Likert-scale questionnaires on motivation and self-efficacy, along with summative tests. Data analysis, conducted with R software, employed descriptive statistics, t-tests, Wilcoxon signed-rank tests, and Structural Equation Modeling (SEM). Results indicated significantly heightened motivation (weighted mean=4.17, p=0.056), increased self-efficacy (weighted mean=4.2, p=0.04), and improved academic performance (weighted mean=38.69, p=0.00) among students using OCL-STAD. Path analysis revealed the direct effects of self-efficacy on academic achievement (path coefficient=0.25) and motivation (path coefficient=0.04). Keywords: motivation, online cooperative learning, Student Teams Achievement Divisions (STAD) method, self-efficacy

Simultaneous detection of dental caries and fissure sealant in intraoral photos by deep learning: a pilot study

BackgroundDeep learning, as an artificial intelligence method has been proved to be powerful in analyzing images. The purpose of this study is to construct a deep learning-based model (ToothNet) for the simultaneous detection of dental caries and fissure sealants in intraoral photos.MethodsA total of 1020 intraoral photos were collected from 762 volunteers. Teeth, caries and sealants were annotated by two endodontists using the LabelMe tool. ToothNet was developed by modifying the YOLOX framework for simultaneous detection of caries and fissure sealants. The area under curve (AUC) in the receiver operating characteristic curve (ROC) and free-response ROC (FROC) curves were used to evaluate model performance in the following aspects: (i) classification accuracy of detecting dental caries and fissure sealants from a photograph (image-level); and (ii) localization accuracy of the locations of predicted dental caries and fissure sealants (tooth-level). The performance of ToothNet and dentist with 1year of experience (1-year dentist) were compared at tooth-level and image-level using Wilcoxon test and DeLong test.ResultsAt the image level, ToothNet achieved an AUC of 0.925 (95% CI, 0.880–0.958) for caries detection and 0.902 (95% CI, 0.853–0.940) for sealant detection. At the tooth level, with a confidence threshold of 0.5, the sensitivity, precision, and F1-score for caries detection were 0.807, 0.814, and 0.810, respectively. For fissure sealant detection, the values were 0.714, 0.750, and 0.731. Compared with ToothNet, the 1-year dentist had a lower F1 value (0.599, p < 0.0001) and AUC (0.749, p < 0.0001) in caries detection, and a lower F1 value (0.727, p = 0.023) and similar AUC (0.829, p = 0.154) in sealant detection.ConclusionsThe proposed deep learning model achieved multi-task simultaneous detection in intraoral photos and showed good performance in the detection of dental caries and fissure sealants. Compared with 1-year dentist, the model has advantages in caries detection and is equivalent in fissure sealants detection.

The Effectiveness of Education with Picture Media to Increase Students’ Knowledge and Attitudes about Maintaining the Cleanliness of the External Genitalia at Al-Azhar26 Junior High School Yogyakarta

Background: Cleanliness of women’s genitals is related to the menstrual cycle. The education of menstruation with picture media increases women’s awareness to maintain the cleanliness of the external genital because picture media shows effects of risk behavior if do not maintain the cleanliness. Women with a better understanding of menstruation often have a safe and clean way to manage their menstrual bleeding. Poor knowledge, attitudes and actions towards external genitalia hygiene in adolescent girls have clinical implications, namely the occurrence of infections in the reproductive system and urinary tract infections. In developing countries, this problem needs more serious attention.Objective: This study aims to analyze the effectiveness of education with picture media to increase students’ knowledge and attitudes about maintaining the cleanliness of the external genitalia at Al-Azhar 26 Junior High School Yogyakarta.Methods: This research is a quantitative study with a quasi-experimental design and uses analytic research with a One Group Pretest- Postest Design. In this study there was no control group, data collection using a questionnaire. The population was made up of Grade VIII students of junior high schools who were actively studying at MTs Al- Azhar 26 Yogyakarta. Respondents came from junior high school students because junior high school students represented teenagers and their intellectual abilities were not much different. The research sample was taken by using a total sampling technique of 60 samples. The treatment procedure was after completing the pre-test, students were given education about external genital hygiene with picture media. After receiving education, students were asked to fill out a post test, after the data was collected, data analysis was carried out using the Wilcoxon test. Ethical permission for this research from FKIK UMY with number 106/EC-KEPK FKIK UMY/IV/2021.Results: Respondents are 60, aged 12 and 13 years. The mean value of knowledge before intervention is 7,02, the mean value of knowledge after intervention is 13,68. The mean value of the attitude before the intervention was 15.35, the mean value of the attitude after the intervention was 33.23. The results of the test on the level of knowledge of the respondents using the Wilcoxon test obtained a value of p = 0.001 (p &lt;0.05), this is a significant result in increasing the level of knowledge of respondents about external genitalia hygiene. The results of the test on respondents’ attitudes using the Wilcoxon test obtained p value = 0.001 (p &lt; 0.05), this is a significant result in increasing respondents’ attitudes about the external genitalia.Conclusion: counseling about genital hygiene is effective in increasing knowledge and attitudes about female genitalia in Yogyakarta. Efforts to improve external genital hygiene in adolescents need to be continuously improved with education that is carried out continuously and carried out using various methods.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 157-164

Reproducible Radiomics Features from Multi-MRI-Scanner Test-Retest-Study: Influence on Performance and Generalizability of Models.

Radiomics models trained on data from one center typically show a decline of performance when applied to data from external centers, hindering their introduction into large-scale clinical practice. Current expert recommendations suggest to use only reproducible radiomics features isolated by multiscanner test-retest experiments, which might help to overcome the problem of limited generalizability to external data. To evaluate the influence of using only a subset of robust radiomics features, defined in a prior in vivo multi-MRI-scanner test-retest-study, on the performance and generalizability of radiomics models. Retrospective. Patients with monoclonal plasma cell disorders. Training set (117 MRIs from center 1); internal test set (42 MRIs from center 1); external test set (143 MRIs from center 2-8). 1.5T and 3.0T; T1-weighted turbo spin echo. The task for the radiomics models was to predict plasma cell infiltration, determined by bone marrow biopsy, noninvasively from MRI. Radiomics machine learning models, including linear regressor, support vector regressor (SVR), and random forest regressor (RFR), were trained on data from center 1, using either all radiomics features, or using only reproducible radiomics features. Models were tested on an internal (center 1) and a multicentric external data set (center 2-8). Pearson correlation coefficient r and mean absolute error (MAE) between predicted and actual plasma cell infiltration. Fisher's z-transformation, Wilcoxon signed-rank test, Wilcoxon rank-sum test; significance level P < 0.05. When using only reproducible features compared with all features, the performance of the SVR on the external test set significantly improved (r = 0.43 vs. r = 0.18 and MAE = 22.6 vs. MAE = 28.2). For the RFR, the performance on the external test set deteriorated when using only reproducible instead of all radiomics features (r = 0.33 vs. r = 0.44, P = 0.29 and MAE = 21.9 vs. MAE = 20.5, P = 0.10). Using only reproducible radiomics features improves the external performance of some, but not all machine learning models, and did not automatically lead to an improvement of the external performance of the overall best radiomics model. Stage 2.

GPT-4 Turbo with Vision fails to outperform text-only GPT-4 Turbo in the Japan Diagnostic Radiology Board Examination.

To assess the performance of GPT-4 Turbo with Vision (GPT-4TV), OpenAI's latest multimodal large language model, by comparing its ability to process both text and image inputs with that of the text-only GPT-4 Turbo (GPT-4T) in the context of the Japan Diagnostic Radiology Board Examination (JDRBE). The dataset comprised questions from JDRBE 2021 and 2023. A total of six board-certified diagnostic radiologists discussed the questions and provided ground-truth answers by consulting relevant literature as necessary. The following questions were excluded: those lacking associated images, those with no unanimous agreement on answers, and those including images rejected by the OpenAI application programming interface. The inputs for GPT-4TV included both text and images, whereas those for GPT-4T were entirely text. Both models were deployed on the dataset, and their performance was compared using McNemar's exact test. The radiological credibility of the responses was assessed by two diagnostic radiologists through the assignment of legitimacy scores on a five-point Likert scale. These scores were subsequently used to compare model performance using Wilcoxon's signed-rank test. The dataset comprised 139 questions. GPT-4TV correctly answered 62 questions (45%), whereas GPT-4T correctly answered 57 questions (41%). A statistical analysis found no significant performance difference between the two models (P = 0.44). The GPT-4TV responses received significantly lower legitimacy scores from both radiologists than the GPT-4T responses. No significant enhancement in accuracy was observed when using GPT-4TV with image input compared with that of using text-only GPT-4T for JDRBE questions.

Rapid decrease in IL-1Ra and IP-10 plasma levels following tuberculosis treatment initiation

ObjectivesMonitoring tools that could provide quick predictions of tuberculosis (TB) treatment outcomes are urgently needed. Here, we assessed whether the evolution of selected biomarkers of innate immunity may help monitoring TB treatment response within 2 weeks of treatment initiation. MethodsANRS12394-LILAC-TB was a proof-of-concept prospective study: adults with a rifampicin-susceptible TB who are HIV-negative and HIV-infected documented by a positive Xpert MTB/RIF test were enrolled in Cambodia and Côte d'Ivoire. Plasma concentrations of interleukin-1 receptor antagonist (IL-1Ra), interferon-γ–induced protein-10 and clusters of differentiation (CD) (scavenging CD163) were measured by commercial enzyme-linked immunosorbent assay kits. A Wilcoxon test for paired data was used for longitudinal comparisons. ResultsA total of 55 patients were enrolled (women: 31%, median age: 37 years; median CD4 count in the 10 of 13 participants with HIV: 53 cells/mm3). Overall, 83% were considered in TB treatment success. Compared with baseline, the IL-1Ra plasma levels significantly decreased as soon as week (W) 1, independent of HIV status (−71% in HIV-positive vs −33% in HIV-negative; P <0.001). The IP-10 plasma levels significantly decreased at W1 and W2 compared with baseline (P <0.0001); however, that decrease was less marked in participants with HIV. ConclusionsOur findings suggest that measuring IL-1Ra plasma levels with a standard enzyme-linked immunosorbent assay technique at baseline and then 1 week after TB treatment onset could help clinicians to quickly assess TB treatment response.

Comparison of trunk muscle activity during lumbar stabilization exercises on stable and unstable surfaces.

Lumbar stabilization exercises (LSE) provide dynamic trunk stability, promote muscle strength and endurance, and improve low back pain rehabilitation and performance. To clarify the differences in trunk muscle activity during LSEs on stable and different unstable surfaces. Fifteen healthy males performed three exercises (elbow-toe, hand-knee, and side bridge) on stable (floor) and unstable surfaces. Muscle activity of the bilateral rectus abdominis, internal oblique, external oblique, and erector spinae were recorded. Data were compared using the Friedman test. Pairwise comparisons were performed using Wilcoxon's signed rank test if significant differences were observed. In the elbow-toe exercise, muscle activity of the rectus abdominis and right internal oblique increased in the following order: floor, low-difficulty, and high-difficulty unstable surface. In the hand-knee exercise, muscle activity of the internal oblique on the lower-extremity elevated side, external oblique, and erector spinae on the upper-extremity elevated side were greater on unstable surface exercise performance. In the side bridge exercise, rectus abdominis muscle activity was highest on a high-difficulty unstable surface. Trunk muscle activity increased during exercise on unstable surfaces. Since the effects of unstable surfaces vary depending on muscle and exercise types, exercise difficulty and surface stability must be considered accordingly.

Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review.

Injury causes 4.4 million deaths worldwide annually. 90% of all injury-related deaths occur in low-and-middle income countries. Findings from expert-led trauma death reviews can inform strategies to reduce trauma deaths. A cohort of trauma decedents was identified from an on-going study in the Western Cape Province of South Africa. For each case, demographics, injury characteristics, time and location of death and postmortem findings were collected. An expert multidisciplinary panel of reviewed each case, determined preventability and made recommendations for improvement. Analysis of preventable and non-preventable cases was performed using Chi-square, Fisher's exact, and Wilcoxon signed rank tests. A rapid qualitative analysis of recommendations was conducted and descriptively summarized. 138 deaths (48 deceased-on-scene and 90 pre- or in-hospital deaths) were presented to 23 panelists. Overall, 46 (33%) of deaths reviewed were considered preventable or potentially preventable. Of all pre- and in-hospital deaths, late deaths (>24 hours) were more frequently preventable (22, 56%) and due to multi-organ failure and sepsis, compared to early deaths (≤24 hours) with 32 (63%) that were non-preventable and due to central nervous system injury and haemorrhage. 45% of pre and in-hospital deaths were preventable or potentially preventable. The expert panel recommended strengthening community based primary prevention strategies for reducing interpersonal violence alongside health system improvements to facilitate high quality care. For the health system the panel's key recommendations included improving team-based care, adherence to trauma protocols, timely access to radiology, trauma specialists, operative and critical care.

Insertional Achilles tendinopathy: A radiographic cross-sectional comparison between symptomatic and asymptomatic heel of 71 patients

PurposeThis retrospective study aimed to investigate whether the standard radiographic indicators for Haglund's syndrome are applicable to insertional Achilles tendinopathy. MethodsPatients who underwent surgery for insertional Achilles tendinopathy in one heel and experienced no pain in the other heel were enrolled in this study. Preoperative calibrated radiographs of the lateral view of the calcaneus were assessed using (1) calcaneal pitch angle, (2) Fowler-Phillip angle, (3) posterior calcaneal angle, (4) Chauveau-Liet angle, (5) X/Y ratio, (6) Haglund’s deformity height, (7) Haglund’s deformity peak angle, (8) calcification length, (9) calcification width, (10) parallel pitch test, and (11) presence of free body. The Wilcoxon signed rank test and McNemar’s test were used for statistical analyses. ResultsSeventy-one patients (52 males; mean age, 57.2; mean body mass index, 27.1) were included. Mean values for each index in the symptomatic and asymptomatic heels were as follows, respectively: (1) 23.5, 23.0 (p = 0.30); (2) 58.9, 57.8 (p < 0.05); (3) 7.6, 9.2 (p < 0.05); (4) 15.8, 13.9 (p < 0.05); (5) 2.8, 2.8 (p = 0.87); (6) 5.4, 5.0 (p < 0.05); (7) 99.6, 99.0 (p = 0.44); (8) 10.5, 7.6 (p < 0.001); and (9) 5.1, 4.4 (p < 0.05). The sensitivity, specificity, and area under curve of significant indicators were as follows, respectively: (2) 0.78, 0.37, 0.55; (3) 0.45, 0.72, 0.58; (4) 0.63, 0.54, 0.57; (6) 0.45, 0.69, 0.59; (8) 0.48, 0.80, 0.66; and (9) 0.63, 0.54, 0.59. The presence of free body also showed a significant difference between both heels (p < 0.05). ConclusionSome radiographic indicators for Haglund's syndrome are applicable to the diagnosis of insertional Achilles tendinopathy. A comparison of the parameters of Haglund’s syndrome with those of insertional Achilles tendinopathy may illuminate the etiology and pathology of insertional Achilles tendinopathy and lead to novel treatments.

Assessment of pulmonary vascular anatomy: comparing augmented reality by holograms versus standard CT images/reconstructions using surgical findings as reference standard

BackgroundWe compared computed tomography (CT) images and holograms (HG) to assess the number of arteries of the lung lobes undergoing lobectomy and assessed easiness in interpretation by radiologists and thoracic surgeons with both techniques.MethodsPatients scheduled for lobectomy for lung cancer were prospectively included and underwent CT for staging. A patient-specific three-dimensional model was generated and visualized in an augmented reality setting. One radiologist and one thoracic surgeon evaluated CT images and holograms to count lobar arteries, having as reference standard the number of arteries recorded at surgery. The easiness of vessel identification was graded according to a Likert scale. Wilcoxon signed-rank test and κ statistics were used.ResultsFifty-two patients were prospectively included. The two doctors detected the same number of arteries in 44/52 images (85%) and in 51/52 holograms (98%). The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433). In particular, the mean difference in the number of arteries detected in the upper lobes was 0.67 ± 1.08 between surgery and CT images and 0.17 ± 0.46 between surgery and holograms (p = 0.029). Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81) and found holograms easier to evaluate than CTs (p < 0.001).ConclusionsAugmented reality by holograms is an effective tool for preoperative vascular anatomy assessment of lungs, especially when evaluating the upper lobes, more prone to anatomical variations.Trial registrationClinicalTrials.gov, NCT04227444Relevance statementPreoperative evaluation of the lung lobe arteries through augmented reality may help the thoracic surgeons to carefully plan a lobectomy, thus contributing to optimize patients’ outcomes.Key points• Preoperative assessment of the lung arteries may help surgical planning.• Lung artery detection by augmented reality was more accurate than that by CT images, particularly for the upper lobes.• The assessment of the lung arterial vessels was easier by using holograms than CT images.Graphical

Do you really drink a single glass of wine a day? A cross-sectional study on self-reported and next-of-kin observed alcohol consumption

ABSTRACT Objective To evaluate the difference between self-reported and patients’ relative’s appreciation of alcohol consumption for patients with risky alcohol use. Methods Patients with risky alcohol use, admitted to general internal medicine wards, completed a questionnaire on drinking habits at hospital admission and 3 days later. The questionnaire contained the preceding week’s number of standard units (SU) alcohol consumption and the AUDIT C screening tool. A close relative completed a similar questionnaire about the patient’s drinking habits. The difference between self-report and proxy observed consumption was tested through Wilcoxon signed-rank test; differences in AUDIT C score were tested through paired t-test. Results Between March 2017 and May 2019, 46 patients were included. There was a significant difference between median self-reported (23.9 SU/week; IQR: 13.0–39.0) and relative’s (46.3 SU/week; IQR: 25.3–70.0) estimations of consumption (median difference of 12.4 SU/week; IQR 0–33.4, p < .001), and mean self-reported (6. 9; 95% CI:6.0–7.8) and relative’s (8.9, 95% CI: 8.0–9.7) estimations of the AUDIT-C Score (mean difference of 2.0; 95% CI: 1.1–2.8, p < .001). Conclusions Relative’s reported alcohol consumption is around two-fold higher than self-reported. Taking a history from a close relative could strengthen the confidence in the actual drinking habits of a patient.

The A2ml1-Knockout mouse as an animal model for non-syndromic otitis media

BackgroundInflammation and infection of the middle ear, known as otitis media (OM), is a leading cause of hearing loss and the most frequently diagnosed disease in children worldwide. Traditionally, mouse models for OM rely on inducing acute infection through inoculation of the middle ear, e.g. with the human otopathogen non-typeable Haemophilus influenzae (NTHi), and with very few genetic models with spontaneous or chronic OM. A2ML1 variants, including loss-of-function variants, were associated with susceptibility to OM in humans, but no animal model has been reported for A2ml1-related OM. Here, we report our middle ear findings in a mouse line with a CRISPR-induced knockout (KO) of A2ml1. MethodsMice were X-rayed prior to harvest to determine if there are craniofacial or skeletal abnormalities. Tissue from mouse middle ears, as well as other upper respiratory mucosal tissues, were harvested. The harvested middle ear bullae were examined under microscope and submitted for histologic preparation to study phenotypic indications of OM. RNA samples isolated from middle ear tissue were assayed for expression of genes correlated with A2ML1 expression in humans. ResultsData from a total of 119 mice (35 wildtype, 40 heterozygous, 44 homozygous) are presented here, with each analyses being performed on subsets of these mice. There were no significant craniofacial differences by genotype (n = 22). Findings in mice with the A2ml1-KO indicated an increased incidence of OM (n=29; odds ratio = 11; CI: 1.1, 573.6; Fisher exact two-sided p = 0.02) with tympanic membrane perforations or thickening, as well as cases of middle ear effusion, inflammatory cells, or fluid from histologic sections. Dsp was upregulated in the middle ear tissues of homozygous mice (Wilcoxon test p = 0.001). ConclusionThus far, our results in this A2ml1-KO mouse line indicate spontaneous occurrence of OM and dysregulation of Dsp in the middle ear as a potential disease mechanism for A2ml1-related OM.